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r�- <br /> :_ <br /> .. •Dat@ � 2 �� / Pub��c Worke Permit e �— <br /> ApplicationFor /y�L�y' oiaq.osa�.s <br /> v�/J � � i i <br /> PUBLIC WORKS PERMlT • PuEIICWo�keFee <br /> n� A� Totel Fee s J Z7a <br /> �`v leae AVG�Fee P�Id S—�1-� <br /> Bel�nce Due � <br /> �� �v4'� <br /> r Print or Type Only <br /> �V�l P`��-1.� �R►-1F Z JO Z Zv.L�ri F_2 KJ'�'2r-t�'1 � '_7�20� Z 5Z - Z\j� <br /> Owner Meiling Address City Zip Phone <br /> d <br /> �A�� <br /> Applicant Mailing Address City Zip Phone <br /> DMcribe ProPosed Workl S�d� ��C�-P.�r-i(>C.��z �F�l STw1. ��a-�9v-�. �v r _ <br /> , N(_W .�/ 14LC�-j��f�i�_��-2�r�c�_ C r=tiC�k�2 � C� _Ys-c�C� <br /> � <br /> � I L <br /> ` W <br /> -� proJect Addrsee(it known) � <br /> A•���Atl�ch tour(4)copiea of plana for propoaed work-Draw to scele and note the following as applicable: � <br /> • Propsrty Lines . • Centerline of street � <br /> •Outlins�nd dlmenaione of all exiating end • Indtcate North <br /> propwed structurea on the lot • Show any proposed greding chenges <br /> • Ezlatinq end propoeed utilities • Show measurements /M <br /> W <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells lor Inspectlon shall be mede 24 hrs in advance•phone 259•8815. � <br /> 2. All work shall be peAormed in accordence with thia permit and currenl City of Everetl Design and Constructlan <br /> � Standarda and Specificatlona <br /> x 3. Csll Locatlon Underpround SeMce 48 hrs before yau dig.TOLL FREE NUMBER 1-800�424•5555. � <br /> �, � ��joY'ed ,C�� lIa/� 3 �/2-PJ7 O <br /> / <br /> � <br /> � <br /> O <br /> a <br /> - ACKNOWLE6GEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> less the City ot Everett from any and all claims tor damage& costs, <br /> % expenses, or ceuses of action that mey arise beceuse of inatalletion <br /> yand mafntenance ot the improvement or other right•of-way use hereto <br /> � �3� applled for and further agrees to remove seme upon notice irom the <br /> :���npp1, for CD tmc ate Cit and to replace public property damaged thereby. <br /> � / <br /> -�flNAI IN3PECTION Date <br /> i Approv�d n Conetructed gn ure of Ap ent - Dete <br /> PUBLIC WOFKS DEPARTMENT 0 K AU7HORIZED BY T (, f-E MUST B£ STARTED WITHIN <br /> ':. Mrelt 1 DAYS OF DATE PERMIT 13 IS UED AND THEREAFTER IS TO '� <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMVLElION.THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY TME CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:269•8615 PROJECT OVER 90 DAYS DURATION. <br /> 'T... , <br />